| Field Name | Value |
| Select a Class | Micro - 2,500 sq. ft. Max. |
| Field Name |
| COMPANY NAME(legal name, and any d/b/a name(s), if applicable) |
| Street Address 1 |
| City |
| State |
| Zip code |
| Telephone Number |
| Are the premises owned or leased by the Applicant? |
| Field Name |
| Street Address 1 |
| City |
| State |
| Zip code |
| Field Name |
| Street Address 1 |
| City |
| State |
| Zip Code |
| Telephone Number |
| Field Name |
| First Name |
| Last Name |
| Title |
| Street Address |
| City |
| State |
| Zip Code |
| Telephone Number |
| Signature |
| Field Name | Data Type | Value |
| COMPANY NAME | Text_SF | Automation Company |
| FEIN | Text_SF | 727829090 |
| Street Address 1 | Text_SF | Cranston Street 102 |
| City | Text_SF | Cranston |
| Zip code | Text_SF | 87656 |
| Telephone Number | Text_SF | 9291010101 |
| Text_SF | automationer@ri.com |
| Field Name | Value |
| Street Address 1 | Right Bright Road |
| City | Cranston |
| Zip code | 02883 |
| Are the premises owned or leased by the Applicant? | Owned |
| Field Name | Value |
| Street Address 1 | Right Bright Street Road |
| City | Cranston |
| Zip Code | 02883 |
| automation@ri.com | |
| Telephone Number | 9797010101 |
| Field Name | Value |
| First Name | Automation First |
| Last Name | Automation Last |
| Title | Automation Tester |
| Street Address | Rhode Island Avenue Street |
| City | Providence |
| State | Rhode Island |
| Zip Code | 02903 |
| Email Address | automater@ri.com |
| Telephone Number | 9797020202 |
| Signature | automater |
| Field Name |
| The undersigned attests that the Licensee organization understands and will adhere to the all requirements of the Act and the Regulations, including but not limited to those listed above, and that they have the authority to bind the Licensee organization to all requirements. |
| I understand that I will be required to use the state approved Medical Marijuana Program Tracking System in accordance with the Regulations and that access to and use of this system may come at an additional expense. |
| Signature |
| Field Name | Data Type | Value |
| Signature | Text_SF | AutomationCompany |
| Field Name | Data Type | Value |
| Individual | Radiobutton | true |
| Select a Contact | Dropdown | Add New |
| Field Name |
| First Name |
| Last Name |
| Title |
| Street Address |
| City |
| State |
| Zip |
| Phone Number |
| Own. % Business Associated with |
| Effective Own. % in Applicant |
| Business Associated with (Applicant, parent business or sub-entity) |
| Date of Birth |
| Field Name | Data Type | Value |
| First Name | Text_SF_Unique | Automation Company |
| Last Name | Text_SF | Laster |
| Title | Text_SF | AutoTitle |
| SSN | Text_SF | 727829190 |
| Date of Birth | Text_SF | Nov 30, 1983 |
| Street Address | Text_SF | Cranston Street 102 |
| City | Text_SF | Cranston |
| Zip | Text_SF | 897656 |
| State | Dropdown | Arizona |
| Phone Number | Text_SF | 97891010101 |
| Text_SF_Unique | autotioemo@ri.com | |
| Own. % Business Associated with | Text_SF | 40 |
| Effective Own. % in Applicant | Text_SF | 40 |
| Business Associated with (Applicant, parent business or sub-entity) | Text_SF | AutoGuy |
| Field Name |
| The undersigned duly authorized officer of the applicant/licensee, in his/her capacity as such officer and for and on behalf of the applicant/licensee, after due inquiry, hereby certifies to the Office of Cannabis Regulation of the Department of Business Regulation (the “Department” or “DBR”) that it/he/she has disclosed to the Department in this Form 2: |
| Signature |
| Field Name | Data Type | Value |
| Signature | Text_SF | Automater |
| Field Name |
| Signature |
| Field Name | Data Type | Value |
| If “Yes” provide a brief explanation, copies of all documentation and name/address/phone number/contact person for the licensing/registration/authorization authority. | Dropdown | No |
| Signature | Text_SF | Automater |
| Field Name |
| 1. Does the Applicant, any Interest Holder or any Marijuana business entity or its equivalent in which such persons hold or have held an interest, has had a registration or license, suspended, revoked, placed on probationary status or subject to any disciplinary action. |
| 2. Is the Applicant or any Interest Holder is delinquent on the filing and/or payment of State or Federal taxes. |
| 3. Has the Applicant or any Interest Holder or any Marijuana business entity or its equivalent in which such persons hold or have held an interest holds or has held a medical Marijuana or medical marijuana license or registration in another State, have any such person(s) been disciplined (including, but not limited to restricted, suspended, or terminated) by any State? |
| 4. Has the Applicant or any Interest Holder been denied a professional license, privilege of taking an examination, or had a professional license or permit disciplined by a licensing authority in Rhode Island or other State. |
| 5. Is any Interest Holder employed by the State of Rhode Island? |
| 6. Does any Interest Holder have any “material financial interest or control” (as defined in Section 1.5(E)(5) of the Regulations) in another licensed cultivator, a compassion center, a licensed cooperative cultivation, or a Rhode Island DOH licensed third party testing provider or vice versa. |
| 7. Since the initial License date or the last renewal, whichever is the most recent, has the Applicant or any Interest Holder been convicted of or pled nolo contender to a crime other than a minor traffic violation? |
| 8. I acknowledge that I fully understand that: |
| Signature |
| Field Name | Data Type | Value |
| 1. Does the Applicant, any Interest Holder or any Marijuana business entity or its equivalent in which such persons hold or have held an interest, has had a registration or license, suspended, revoked, placed on probationary status or subject to any disciplinary action. | Dropdown | No |
| 2. Is the Applicant or any Interest Holder is delinquent on the filing and/or payment of State or Federal taxes. | Dropdown | No |
| 3. Has the Applicant or any Interest Holder or any Marijuana business entity or its equivalent in which such persons hold or have held an interest holds or has held a medical Marijuana or medical marijuana license or registration in another State, have any such person(s) been disciplined (including, but not limited to restricted, suspended, or terminated) by any State? | Dropdown | No |
| 4. Has the Applicant or any Interest Holder been denied a professional license, privilege of taking an examination, or had a professional license or permit disciplined by a licensing authority in Rhode Island or other State. | Dropdown | No |
| 5. Is any Interest Holder employed by the State of Rhode Island? | Dropdown | No |
| 6. Does any Interest Holder have any “material financial interest or control” (as defined in Section 1.5(E)(5) of the Regulations) in another licensed cultivator, a compassion center, a licensed cooperative cultivation, or a Rhode Island DOH licensed third party testing provider or vice versa. | Dropdown | No |
| 7. Since the initial License date or the last renewal, whichever is the most recent, has the Applicant or any Interest Holder been convicted of or pled nolo contender to a crime other than a minor traffic violation? | Dropdown | No |
| 8. I acknowledge that I fully understand that: | Checkbox | True |
| Signature | Text_SF | Automater |
| Field Name |
| Please describe any changes or updates to your business plan that affect scope of proposed activities (cultivation, manufacturing methods, products to be produced, packaging/labeling), budget and resource narratives and/ or, appropriate employee working conditions, benefits and training. |
| Has the Applicant filed all required tax returns and is not in arrears regarding any tax obligation in Rhode Island and other jurisdictions? |
| Please provide a list of products being grown and/or manufactured. |
| A. Federal and State Medical Marijuana laws |
| B. Standard operating procedures. |
| C. Detection and prevention of diversion of medical Marijuana. |
| D. Safety procedures, including responding to a (1) medical emergency, (2) a fire, and (3) a chemical spill. |
| E. Safety procedures, including responding to threatening events including an armed robbery, an invasion, a burglary, and any other criminal incident. |
| A. Secured the licensed premises and facility for cultivation of medical Marijuana to prevent unauthorized entry in accordance with the Regulations. |
| B. Equipped the premises with adequate security lighting and a security alarm system that (1) covers the entire perimeter, as well as all perimeter entry points and portals at all premises (2) is continuously monitored, and (3) is capable of detecting smoke and fire, as well as power loss/interruption in accordance with the Regulations. |
| C. Protected the premises by a video surveillance recording system to ensure surveillance of the entire perimeter of the area of cultivation, manufacturing and storage and adherence to the video surveillance requirements. As well as interior video surveillance that (1) records all activity in images of high quality and high resolution capable of clearly revealing facial detail, (2) operates 24-hours a day, 365 days a year without interruption, and (3) provides a date and time stamp for every recorded frame. The feed is remotely accessible to the Department of Business Regulation and is available to the Department and law enforcement in accordance with the Regulations. |
| A. When visitors are admitted to a non-public area of the licensed premises (1) Licensee logs the visitor in and out, (2) continuously visually supervises the visitor while on the premises, and (3) ensures that the visitor does not touch any plant or medical Marijuana. |
| B. Maintain a log of all visitors and has attached visitor log at the bottom the page for the previous licensed year. |
| A. Promote good growing and handling practices including all aspects of the (1) irrigation, propagation, cultivation, and fertilization, (2) harvesting, drying, and curing, (3) processing or manufacturing, (4) packaging, labeling, and handling of medical Marijuana byproduct, and (5) waste products, and the control thereof, to promote good growing and handling practices. |
| B. Promote good growing and handling practices including requiring that each individual engaged in the cultivation, manufacturing, handling, and packaging, of medical Marijuana has the training, education, or experience necessary to perform assigned functions. |
| C. Promote good growing and handling practices including requiring that all registered Cultivator agents practice good hygiene and wear protective clothing as necessary to protect the products as well as themselves from exposure to potential contaminants. |
| D. Promote good growing and handling practices including requirements for receipt of material, including how the Licensee will inspect material for defects, contamination, and compliance with Regulations. |
| E. Promote good growing and maintain records of the type and amounts of, pesticides, fertilizer and any growth additives used. |
| Please certify that the Applicant has used and will continue to use pesticides in accordance with the Regulations and that the Applicant has established written standard operating procedures to ensure their safe use in accordance with regulation and other applicable state law. |
| Please certify that the Applicant has sealed or screened the premises to exclude contaminants. |
| Please certify that sanitation has been maintained through the facility in accordance with the Regulations. |
| Please certify that the Licensee will notify the Department of Business Regulation of a meaningful discrepancy, if the Licensee discerns a discrepancy between the inventory of stock and inventory control outside of normal weight loss due to moisture loss and handling. |
| Please certify that the Applicant has/will record(ed) and execute(ed) the transfer of marijuana in accordance with the Regulations. |
| Please certify that the Applicant has/will not release(ed) any batch of medical Marijuana if the batch fails to meet all criteria for production or patient consumption in accordance with the Regulations. |
| Please certify that the Applicant has/will ensure(ed) it does not transport medical marijuana to or receive(ed) any medical marijuana from any place outside of Rhode Island. |
| A. Require(ed) that any person involved in processing medical marijuana concentrates and medical marijuana-infused products is (1) appropriately trained in accordance to their job description to safely operate and maintain the system used for processing and attendance records are retained, (2) has direct access to applicable material safety sheets and labels, and (3) follows protocols for handling and storage of all chemicals. |
| B. Establish(ed) a standard operating procedure for the methods, equipment, solvents, and gases when processing medical marijuana concentrates and medical marijuana-infused products. |
| C. If the Applicant uses solvent extraction, the standard operating procedure of Applicant uses best practices to ensure worker and product safety; and follows all applicable federal, state, and local fire, safety, and building codes in the processing and storages of the solvents. |
| All packaging and labeling marijuana finished products has and will continue to be in compliance with all applicable Regulations. |
| All advertising done by or on behalf of the licensee has and will continue to be in compliance with all applicable Regulations. |
| Camera Access: Please provide the Applicant’s security camera system’s IP address, username and password for DBR access. |
| Signature |
| Field Name | Data Type | Value |
| Please describe any changes or updates to your business plan that affect scope of proposed activities (cultivation, manufacturing methods, products to be produced, packaging/labeling), budget and resource narratives and/ or, appropriate employee working conditions, benefits and training. | Double quotes | test |
| Has the Applicant filed all required tax returns and is not in arrears regarding any tax obligation in Rhode Island and other jurisdictions? | Dropdown | Yes |
| Please provide a list of products being grown and/or manufactured. | Double quotes | test |
| A. Federal and State Medical Marijuana laws | Dropdown | Yes |
| B. Standard operating procedures. | Dropdown | Yes |
| C. Detection and prevention of diversion of medical Marijuana. | Dropdown | Yes |
| D. Safety procedures, including responding to a (1) medical emergency, (2) a fire, and (3) a chemical spill. | Dropdown | Yes |
| E. Safety procedures, including responding to threatening events including an armed robbery, an invasion, a burglary, and any other criminal incident. | Dropdown | Yes |
| A. Secured the licensed premises and facility for cultivation of medical Marijuana to prevent unauthorized entry in accordance with the Regulations. | Dropdown | Yes |
| B. Equipped the premises with adequate security lighting and a security alarm system that (1) covers the entire perimeter, as well as all perimeter entry points and portals at all premises (2) is continuously monitored, and (3) is capable of detecting smoke and fire, as well as power loss/interruption in accordance with the Regulations. | Dropdown | Yes |
| C. Protected the premises by a video surveillance recording system to ensure surveillance of the entire perimeter of the area of cultivation, manufacturing and storage and adherence to the video surveillance requirements. As well as interior video surveillance that (1) records all activity in images of high quality and high resolution capable of clearly revealing facial detail, (2) operates 24-hours a day, 365 days a year without interruption, and (3) provides a date and time stamp for every recorded frame. The feed is remotely accessible to the Department of Business Regulation and is available to the Department and law enforcement in accordance with the Regulations. | Dropdown | Yes |
| A. When visitors are admitted to a non-public area of the licensed premises (1) Licensee logs the visitor in and out, (2) continuously visually supervises the visitor while on the premises, and (3) ensures that the visitor does not touch any plant or medical Marijuana. | Dropdown | Yes |
| B. Maintain a log of all visitors and has attached visitor log at the bottom the page for the previous licensed year. | Dropdown | Yes |
| A. Promote good growing and handling practices including all aspects of the (1) irrigation, propagation, cultivation, and fertilization, (2) harvesting, drying, and curing, (3) processing or manufacturing, (4) packaging, labeling, and handling of medical Marijuana byproduct, and (5) waste products, and the control thereof, to promote good growing and handling practices. | Dropdown | Yes |
| B. Promote good growing and handling practices including requiring that each individual engaged in the cultivation, manufacturing, handling, and packaging, of medical Marijuana has the training, education, or experience necessary to perform assigned functions. | Dropdown | Yes |
| C. Promote good growing and handling practices including requiring that all registered Cultivator agents practice good hygiene and wear protective clothing as necessary to protect the products as well as themselves from exposure to potential contaminants. | Dropdown | Yes |
| D. Promote good growing and handling practices including requirements for receipt of material, including how the Licensee will inspect material for defects, contamination, and compliance with Regulations. | Dropdown | Yes |
| E. Promote good growing and maintain records of the type and amounts of, pesticides, fertilizer and any growth additives used. | Dropdown | Yes |
| Please certify that the Applicant has used and will continue to use pesticides in accordance with the Regulations and that the Applicant has established written standard operating procedures to ensure their safe use in accordance with regulation and other applicable state law. | Dropdown | Yes |
| Please certify that the Applicant has sealed or screened the premises to exclude contaminants. | Dropdown | Yes |
| Please certify that sanitation has been maintained through the facility in accordance with the Regulations. | Dropdown | Yes |
| Please certify that the Licensee will notify the Department of Business Regulation of a meaningful discrepancy, if the Licensee discerns a discrepancy between the inventory of stock and inventory control outside of normal weight loss due to moisture loss and handling. | Dropdown | Yes |
| Please certify that the Applicant has/will record(ed) and execute(ed) the transfer of marijuana in accordance with the Regulations. | Dropdown | Yes |
| Please certify that the Applicant has/will not release(ed) any batch of medical Marijuana if the batch fails to meet all criteria for production or patient consumption in accordance with the Regulations. | Dropdown | Yes |
| Please certify that the Applicant has/will ensure(ed) it does not transport medical marijuana to or receive(ed) any medical marijuana from any place outside of Rhode Island. | Dropdown | Yes |
| A. Require(ed) that any person involved in processing medical marijuana concentrates and medical marijuana-infused products is (1) appropriately trained in accordance to their job description to safely operate and maintain the system used for processing and attendance records are retained, (2) has direct access to applicable material safety sheets and labels, and (3) follows protocols for handling and storage of all chemicals. | Dropdown | Yes |
| B. Establish(ed) a standard operating procedure for the methods, equipment, solvents, and gases when processing medical marijuana concentrates and medical marijuana-infused products. | Dropdown | Yes |
| C. If the Applicant uses solvent extraction, the standard operating procedure of Applicant uses best practices to ensure worker and product safety; and follows all applicable federal, state, and local fire, safety, and building codes in the processing and storages of the solvents. | Dropdown | Yes |
| All packaging and labeling marijuana finished products has and will continue to be in compliance with all applicable Regulations. | Dropdown | Yes |
| All advertising done by or on behalf of the licensee has and will continue to be in compliance with all applicable Regulations. | Dropdown | Yes |
| Camera Access: Please provide the Applicant’s security camera system’s IP address, username and password for DBR access. | Double quotes | test |
| Signature | Text_SF | Automater |
| Field Name | Data Type | Value |
| Payment Type | Dropdown | Credit/Debit Card |
| Field Name | Data Type | Value |
| First Name | Text_SF | First Automater |
| Last Name | Text_SF | Last Automater |
| Address * | Text_SF | Street Address On Avenue Road |
| City | Text_SF | Providence |
| State * | Dropdown | AL - Alabama |
| ZIP/Postal Code * | Text_SF | 02803 |
| Field Name | Data Type | Value |
| Credit Card Number * | Text_SF | 4111111111111111 |
| Expiration Month | Dropdown | 01 - January |
| Expiration Year | Dropdown | 2025 |
| Name on Credit Card * | Text_SF | Automater |
| Timestamp | TestName | Status |
|---|---|---|
| Dec 30, 2022 08:03:24 PM | Validating the Intake Flow of Commercial Medical Marijuana Cultivator License..1.Validate that the Licensing portal happy path flow of Commercial Medical Marijuana Cultivator License Application. | pass |
| Name | Value |
|---|---|
| User Name | priyaranjan.reddy_mt |
| Time Zone | Asia/Calcutta |
| Machine | Windows 10 - 64 Bit |
| Selenium | 3.7.0 |
| Maven | 3.6.3 |
| Java Version | 1.8.0_151 |
| Name | Passed | Failed | Others | Passed % |
|---|---|---|---|---|
| @CommercialMarijuanaCultivator1 | 1 | 0 | 0 | 100% |